城乡居民医保省级统筹、就医行为与医疗费用增长  

Provincial overall planning of basic medical insurance for urban and rural residents,healthcare-seeking behavior and medical expense growth

作　　者：谢明明 杨洁 杨晔 XIE Ming-ming;YANG Jie;YANG Ye(Business School,Zhengzhou University,Zhengzhou Henan 450001,China)

机构地区：[1]郑州大学商学院,河南郑州450001

出　　处：《中国卫生政策研究》2024年第11期10-18,共9页Chinese Journal of Health Policy

基　　金：国家社会科学基金青年项目(20CSH029)。

摘　　要：目的:分析城乡居民医保省级统筹对医疗费用的影响,以评估其政策效果。方法:基于2012-2020年中国家庭追踪调查数据(CFPS)五期面板数据,采用双重差分模型(DID)检验城乡居民医保省级统筹对医疗费用的影响及其作用机制。结果:城乡居民医保省级统筹显著促进了总医疗费用的增长,且按诊疗方式(门诊和住院费用)和按支付渠道(自付和报销费用)区分的各项医疗费用同样有显著上涨,尤其是报销费用上涨显著。中介效应和调节效应分析显示,省级统筹政策的实施会通过就医行为影响参保人各项医疗费用,个体健康水平对省级统筹政策与医疗费用支出间的影响具有显著的正向调节效应。异质性分析发现,省级统筹对医疗费用的正向影响在青年人群、农村参保群体及患有慢性病的参保群体中的作用更为显著。结论和建议:考虑不同统筹地区医疗资源配置和医疗保障治理能力的差异,因地制宜推进城乡居民医保省级统筹;建立统一的医保政策;加强跨区域医疗资源整合,促进优质医疗资源向基层倾斜。Objective:Analyze the impact of provincial overall planning of urban-rural resident medical insurance on medical expenses,in order to evaluate the policy effectiveness of provincial overall planning of residents medical insurance.Methods:Based on the five period panel data of China Family Panel Studies(CFPS)from 2012 to 2020,a Difference in Differences(DID)Model was used to test the impact and mechanism of the provincial overall planning of urban-rural resident medical insurance on medical expenses.Results:The provincial overall planning policy of basic medical insurance for residents significantly promotes the growth of total medical expenses,and various medical expenses classified by diagnosis and treatment methods(hospitalization and outpatient expenses)and payment channels(out of pocket expenses,reimbursement expenses)also show significant increases,especially in reimbursable expenses.The analysis of intermediary and mediation effects shows that the implementation of provincial overall planning policies will affect the various medical expenses of insured persons through their healthcare-seeking behavior.Individual health levels have a significant positive moderating effect.Heterogeneity analysis found that the positive impact of provincial overall planning on medical expenses is more significant among young people,rural insured groups,and insured groups with chronic diseases.Conclusions and suggestions:Considering the differences in medical resource allocation and medical security governance capabilities in different coordinated regions,it is necessary to promote the provincial overall planning of residents medical insurance according to local conditions.Establish a unified medical insurance policy.Strengthen the integration of cross regional medical resources and promote the tilt of high-quality medical resources towards the grassroots level.

关 键 词：省级统筹 城乡居民医保 医疗费用 就医行为 

分 类 号：R197[医药卫生—卫生事业管理]